Modified thoracoscopic pleural cryo-biopsy in diagnosis of exudative pleural effusion of undetermined etiology

Baess, Ayman Ibrahim; Hassanein, Essam Gouda; Emara, Mohamed Al Saeed; Eshmawey, Heba Ahmed

doi:10.1186/s43168-021-00069-8

Cited by 3 publications

(1 citation statement)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All studies were published after 2015. Among those 15 studies, eight prospective studies ( 12 , 15 , 17 , 20 , 21 , 28 – 30 ), four retrospective studies ( 13 , 18 , 19 , 31 ), two cases series ( 14 , 16 ) and one randomized controlled trial ( 23 ) were analyzed, comprising 1061 biopsies (555 cryobiopsies and 506 forceps biopsies). Cryobiopsy of pleura was obtained in most patients (in 11 out of 15 studies) using cryoprobe 2.4 mm diameter.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

BackgroundPleural cryobiopsy is a novel technique for the diagnosis of pleural pathologies. However, the safety and feasibility of this modality compared to standard forceps for pleural biopsy has not been fully elucidated. This systematic review and meta-analysis aims to establish the efficacy and safety of cryobiopsy for evaluation of undiagnosed pleural effusion.MethodsFor this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of science databases up to December 16, 2021 to identify relevant articles. We included randomized controlled trials, cohort studies, retrospectives studies and case series that compared pleural cryobiopsy and forceps biopsy. A qualitative assessment was performed using the QUADAS-2 tool.ResultsOf the 365 articles identified by our search, 15 studies were eligible for inclusion. The specimen sizes obtained with cryobiopsy were significantly larger compared with forceps biopsy (Standard mean difference 1.16; 95 % CI: 0.51–1.82; P < 0.01). Furthermore, the cryobiopsy tissue specimens were deeper (OR 2.68; 95 % CI: 1.39–5.16; P < 0.01) and qualitatively better with less crush artifacts (OR 0.06; 95 % CI: 0.01–0.26; P < 0.01). There was no significant difference in diagnostic yield (OR 1.32; 95 % CI: 0.79–2.21; P = 0.29) and mild to moderate bleeding events (OR 1.21; 95 % CI: 0.64–2.29; P = 0.57) between pleural cryobiopsy and forceps biopsy. No publication bias was observed among these studies.ConclusionsCompared to flexible forceps biopsy pleural cryobiopsy obtained larger and deeper tissue specimens with less crush artifacts but does not show superiority for diagnostic yield. Further studies are still needed to verify these findings.

show abstract

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

show abstract

Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

El-Morshedy,

El-kholy,

Kamel

et al. 2023

ECDT

View full text Add to dashboard Cite

Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy.

show abstract

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

Chawla,

Kumar,

Madan

et al. 2024

Lung India

View full text Add to dashboard Cite

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

show abstract

Modified thoracoscopic pleural cryo-biopsy in diagnosis of exudative pleural effusion of undetermined etiology

Cited by 3 publications

References 12 publications

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

Efficacy and Safety of Pleural Cryobiopsy vs. Forceps Biopsy for Evaluation of Undiagnosed Pleural Effusion: A Systematic Review and Meta-Analysis

Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

Contact Info

Product

Resources

About